Do you remember the Seinfeld episode where Kramer acts like he has gonorrhea for medical students? Well, we really did have actors in medical school. One of the actors I remembered posed as a patient receiving the news of cancer from me, then a medical student. I walked into the room, not even knowing what kind of cancer she had. I sat down and said, “I have the results of your test. It shows cancer.” She started crying and then I had no idea what to say. I asked, “Are you going to be okay?” The feedback I got was not the greatest. I could’ve been more empathetic… I thought, I hope I never have to do this for a living.
Fast forward to last week. I had a young woman in her forties whose breasts became rock hard 1 month ago. Since then, she had developed facial paralysis in half her face andwas having terrible body aches. She went to the emergency room a few days prior to seeing me and they could only reassure her that she had not had a stroke.
So here I am, meeting her for the first time for a biopsy. She looks horribly ill. I begin the same way I always do, explaining the procedure and what she can expect to feel. She doesn’t really seem to care. She is too focused on the discomfort she is feeling in the rest of her body. As I start to give her her numbing medication, she begins bleeding instantly. I stop and hold some pressure. It appears I am going to be here a bit longer than I really want to be. As I start to place the biopsy needle into her breast, she asks me, “Do I have cancer?”
Not really wanting to have this conversation while performing a difficult biopsy, I reply, “Do you really want to know what I think?” Of course she replies, yes. “I think you have lymphoma, which is a type of cancer.” She starts breaking down crying. I have to continue on with the biopsy. After what feels like hours of sobbing, she then asks me, “Am I going to die?”
The truth was maybe. I have seen women with lymphoma of their breasts die. I reply, “I don’t know.” More sobbing. I then say to her, “I know there is nothing I can say that will make you feel better now. All I can say is that I will get you an answer. Once we have that, we can move forward and get you treatment.”
I am not going to lie and say I wasn’t happy to leave the room when I was done. But once I left the room, I just went on with my day and didn’t really think twice about it. That was until yesterday, when my rep who sells me the biopsy needles (who was in the room during the whole procedure) said, “Wow, that was a really emotional case the other day. That was one of the toughest situations I have seen and you handled it really well.” When I took a step back and thought about it, I tried to picture how I might’ve handled it when I first started. I probably would have just done the procedure and tried to get out of the room as soon as possible.
Over the years, I have accepted the fact that I will never know what it feels like to be on the other side. I will never understand the fears that go through my patient’s heads. The only thing I can do in that moment is to offer support. I can’t promise them that they will live, but I can promise them that I will take care of them and always be there for them. That is what working with cancer for 5 years has taught me, not some actress in medical school. That is the art of medicine.